On Demand Grand Rounds: Difficult to treat depression (DTD): Clinical Value and Research Challenges

This presentation was originally reviewed on January 29, 2024, and broadcast live online on January 31, 2024, from 12:00 PM – 1:00 PM ET. 

The views and opinions expressed by this presenter in this lecture are their own, and do not represent the views of Sheppard Pratt.

Many patients with depression cannot be brought into a state of sustained symptom remission. Sometimes called “treatment resistant” depression, they may be better understood as “difficult to treat depressions” (DTD) because this clinical heuristic promotes the search for treatable pharmacological, psychosocial, and biological/medical obstacles to achieving or sustaining remission. Furthermore, the DTD heuristic recognizes that some depressions may be better managed by optimizing symptom control, quality of life, and daily function, rather than by conducting multiple revisions in treatment from which little, longer-term benefit may be expected. The clinical challenges (e.g., selecting assessments for treatable causes; identifying treatment sequences for specific patients) as well as the research challenges (e.g., defining types of DTD; assessing outcomes) are discussed.

Target Audience

This activity is intended for physicians, nurses, psychologists, social workers, counselors and other mental health professionals. 

Learning Objectives

At the conclusion of this activity, attendees will be able to:

  1. Identify at least 2 important clinical actions recommended when DTD is suspected.
  2. Define three essential treatment goals to optimally manage DTD.
  3. Discuss three research challenges posed by DTD.
Course summary
Available credit: 
  • 1.00 ACEP NBCC clock hours
  • 1.00 AMA PRA Category 1 Credit™
  • 0.00 Category II credits for Social Workers
  • 1.00 Psychologists
  • 1.00 MNA Contact Hours for Nurses
  • 1.00 Participation
Course opens: 
02/29/2024
Course expires: 
02/26/2026

Sheppard Pratt’s Professional Education Program is pleased to provide Wednesdays at Sheppard Pratt free of charge as a public service to the mental health community.  Your tax-deductible donations will help maintain the outstanding quality of this service. 

Sheppard Pratt is dedicated to improving quality of life through mental health, special education, and addiction services for children, adolescents, adults and older adults.  Our patient-centered treatment approach, combined with our legacy of clinical excellence, sets us apart from other health systems on both a local and national level.  We have been ranked among the nation’s top psychiatric hospitals for 24 consecutive years by U. S. News & World Report.  Founded in 1853 by philanthropist Moses Sheppard, Sheppard Pratt Health System still abides by its Quaker traditions and values.

Sheppard Pratt regularly hosts renowned speakers from across the country at our headquarters in Towson. We provide educational opportunities on subjects including psychiatric disorders, issues of behavioral health, systems-based change, mental and somatic co-morbidities, psychiatric effects on health and health outcomes, advances in neurobiology, and clinical developments in concepts underlying drug treatment of psychiatric disorders. We are accredited by the Accreditation Council of Continuing Medical Education, the Maryland Nurses’ Association, the Maryland Board of Psychology, the Maryland Board of Social Work, and the National Board of Certified Counselors.

Please send your contributions to:

Sheppard Pratt Professional Education Program
Grand Rounds Fund
6501 North Charles Street, Baltimore, Maryland 21204

Professional Education Program: 410.938.4593
Conference Center at Sheppard Pratt: 410.938.3900

This lecture was supported by Grant Number 6H79FG000999-01M001 from SAMHSA. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of SAMHSA. 

About the speaker

A. John Rush, MD is Professor Emeritus, National University of Singapore, and Adjunct Professor of Psychiatry Duke School of Medicine, North Carolina. His research has focused on the development and testing of innovative treatments for mood disorders, including medications, brain stimulation, psychotherapeutic and disease management protocols. As author of over 800 peer-reviewed articles, book chapters, and books, his work has received international recognition with awards from many professional organizations, including the American Psychiatric Association, the American College of Psychiatrists, and the Society for Biological Psychiatry among other.  Thomson Reuters recognized Dr. Rush as one of the “World’s Most Influential Scientific Minds” in 2014. As CEO of Curbstone Consultant LLC., he currently provides research and organizational consultation to commercial, governmental, academic, and not for profit organizations, as well individual career mentoring.

Disclosure Statements

Sheppard Pratt holds the standard that its continuing medical education programs should be free of commercial bias and conflict of interest. In accord with Sheppard Pratt's Disclosure Policy, as well as standards of the Accreditation Council for Continuing Medical Education (ACCME) and the American Medical Association (AMA), all planners, reviewers, speakers and persons in control of content have been asked to disclose any relationship he /she has with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months. All planners, reviewers and speakers have also been asked to disclose any payments accepted for this lecture from any entity besides Sheppard Pratt, and if there will be discussion of any products, services, or off-label uses of product(s) during this presentation.

A. John Rush, MD, reports that he has consulted with Compass Inc.,Evecxia Therapeutics, Holmusk Technologies, ICON PLC, Johnson and Johnson, Liva Nova, MindStreet Inc, Neurocrine Biosciences, and Otsuka-US; has received speaking fees from Liva-Nova and Johnson and Johnson; has received royalties from  Wolters Kluwer Health, Guilford Press and the University of Texas Southwestern Medical Center, Dallas, TX (for the Inventory of Depressive Symptoms and its derivatives); and has two US patents. The content of his presentation was reviewed to find and mitigate any conflicts of interest to ensure that the information presented is balanced and evidence-based and contains no logos, brand-names, promotion or advertisements.

Event Planners/Reviewers Disclosures: The following event planners and/or reviewers are reported as having no financial interest, arrangement or affiliation with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months: Todd Peters, MD, Deepak Prabhakar, MD, Elizabeth Ryznar, MD, MSc, Louis Marino, MD, Ehsan Syed, MD, Devi Bhuyan, PsyD, Faith Dickerson, PhD, Carrie Etheridge, LCSW-C, Tom Flis, LCPC, Stacey Garnett, RN, MSN, Stephanie M. Robinson, MSN, RN, PMH-BC, NPD-BC, NE-BC , Heather Billings, RN, Lisa Illum, MLIS, MEd, and Jennifer Tornabene.

Physician Statement: Sheppard Pratt is accredited by The Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity.  Sheppard Pratt designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Statement: Sheppard Pratt is approved as a provider of nursing continuing professional development by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity provides 1.0 contact hour for nurses.

Psychologist Statement: Sheppard Pratt is authorized by the State Board of Examiners of Psychologists as a sponsor of continuing education. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity.  Sheppard Pratt designates this educational activity for a maximum of 1.0 contact hour for Psychologists.

Social Worker Statement: Sheppard Pratt is authorized by the Board of Social Work Examiners of Maryland to offer continuing education for Social Workers.  Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CE activity. This activity is approved for 1.0 contact hour in Category II credits for Social Workers.

Counselor Statement:  Sheppard Pratt has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5098.  Programs that do not qualify for NBCC credit are clearly identified.  Sheppard Pratt is solely responsible for all aspects of the program.  This activity is available for 1.0 NBCC clock hour.

Available Credit

  • 1.00 ACEP NBCC clock hours
  • 1.00 AMA PRA Category 1 Credit™
  • 0.00 Category II credits for Social Workers
  • 1.00 Psychologists
  • 1.00 MNA Contact Hours for Nurses
  • 1.00 Participation
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ON DEMAND WEBINAR: FOR BEST RESULTS WATCH USING GOOGLE CHROME

Grand Rounds: Difficult to treat depression (DTD): Clinical Value and Research Challenges

 John Rush, MD

Professor Emeritus, National University of Singapore

Adjunct Professor of Psychiatry Duke School of Medicine

Durham, NC

Originally reviewed January 29, 2024.
Originally broadcast live January 31, 2024, from 12:00 PM – 1:00 PM ET
Enduring Activity Credit Expiration Date: February 26, 2026.

Activity Time: One-hour webinar lecture with a 15-minute evaluation process. Total Time: 1:15.

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On the OVERVIEW or REGISTER/TAKE COURSE tab, select the GREEN RECTANGLE, TAKE COURSE to begin.
Complete the Pretest and select NEXT in the bottom right corner of the screen. Use the NEXT button for best results.
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After the video follow the prompts to complete the posttest, evaluation, and attestation of credit. 
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